Use of the Omaha System to identify musculoskeletal problems in intensive care unit nurses: a case study.

Br J Nurs. 2019 Mar 14;28(5):300-306

Authors: Sezgin D, Esin MN

Abstract
BACKGROUND:: there is a need for a standard terminology to identify and manage occupational risks in intensive care unit (ICU) settings.
AIM:: this study was conducted to investigate the occupational musculoskeletal symptom-related problems of one ICU nurse using the Omaha system.
METHOD:: a case study method was employed. An Evaluation of Knowledge form and Rapid Upper Limb Assessment tools were used to identify musculoskeletal symptoms and ergonomic risks. Three components of the Omaha System were used: Problem Classification Scheme, Intervention Scheme and Problem Rating Scale for Outcomes.
RESULTS:: eight signs/symptoms related to four problems were identified from three domains: environmental (neighbourhood/workplace safety), physiological (pain and neuro-musculoskeletal function), and health-related behaviours (physical activity and healthcare supervision). Interventions were mapped to Omaha System terms, and nursing outcomes were evaluated.
CONCLUSION:: this study presented an example of using the Omaha System in occupational health nursing practice. The Omaha System can be used effectively to identify musculoskeletal problems and related factors of ICU nurses in a standardised and computerised concept. Use of this system could aid prevention of occupational musculoskeletal problems in ICU nurses.

Abstract
OBJECTIVE: To understand the repercussions of the nurse's clinical practice on Primary Health Care.
METHOD: Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis' Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups.
RESULTS: nurses' clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional's clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice.
FINAL CONSIDERATIONS: Nurses' clinical practice has positive repercussions on the health of Primary Health Care users.

Abstract
Introduction: The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis. The study links the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data with the Defense Manpower Data Center (DMDC) to conduct an examination of the long-term occupational impact of psychiatric aeromedical evacuations on military separations and discharges.
Materials and Methods: Retrospective analyses were conducted on the demographic, clinical, and attrition information of active duty service members (N = 7,023) who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013 using TRAC2ES data. Additionally, TRAC2ES database was compared with DMDC data to analyze personal and service demographics, aeromedical evacuation information, and reasons for military separation with the entire 2013 active duty force. Chi-square tests of independence and standardized residuals were used to identify cells with observed frequencies or proportions significantly different than expected by chance. Additionally, OR were calculated to provide context about the nature of any significant relationships.
Results: Compared with the active duty comparison sample, those with a psychiatric aeromedical evacuation tended to be younger, female, white, divorced or widowed, and less educated. They were also more likely to be junior enlisted service members in the Army serving in a Combat Arms military occupational specialty. The primary psychiatric conditions related to the aeromedical evacuation were depressive disorders (25%), adjustment disorders (18%), post-traumatic stress disorder (9%), bipolar disorders (6%), and anxiety disorders (6%). Approximately, 3% were evacuated for suicidal ideation and associated behaviors. Individuals who received a psychiatric aeromedical evacuation were almost four times as likely (53%) to have been subsequently separated from active duty at the time of the data analysis compared with other active duty service members (14%). The current study also found that peaks in the number of aeromedical evacuations coincided with significant combat operational events. These peaks almost always preceded or followed a significant operational event. An unexpected finding of the present study was that movement classification code was not predictive of subsequent reasons for separation from the military. Thus, the degree of clinical supervision and restraint of a service member during psychiatric aeromedical evacuation from deployment proved to be unrelated to subsequent service outcome.
Conclusions: Psychiatric conditions are one of the leading reasons for the aeromedical evacuation of active duty military personnel from the military combat theater. For many active duty military personnel, a psychiatric aeromedical evacuation from a combat theater is the start of a military career-ending event that results in separation from active duty. This finding has important clinical and operational implications for the evaluation and treatment of psychiatric conditions during military deployments. Whenever possible, deployed military behavioral health providers should attempt to treat psychiatric patients in theater to help them remain in theater to complete their operational deployments. Improved understanding of the factors related to psychiatric aeromedical evacuations will provide important clinical and policy implications for future conflicts.